"Studies show that outside of these select few patients, you don't need it. Yet we've been ordering it routinely on patients and it's completely wasteful. And it's relatively expensive because it has to be run separately from other blood tests in the lab," Moriates says. Besides, a somewhat less accurate calcium test that costs $.50 can signal any problems.
Fast forward a year. A change in the computer ordering set combined with educational efforts have reduced the use of the iCal from 3,660 tests per month in May to just over 1,300 by year's end.
Moriates says he's calculated $150,000 in annual savings in reduced iCal costs, which he admits "is not a ton of money." But the real value is much greater.
"This has been a marker of overuse. When we all agree that this test is unnecessary, we cut it, and then people start thinking about other labs they order. We think there's a big carry-over effect, changing the culture of how people work because they start thinking about what they're ordering."
Although the launch of an electronic ordering system last year and recognition of Choosing Wisely initiatives from the American Board of Internal Medicine Foundation must take part of the credit, Moriates says early financial data indicates direct costs for all labs on the hospital medicine service are down 10% this fiscal year.
Moriates says that to undertake such an effort, it's important from the start to make sure doctors and patients understand that "this is not about taking things away from physicians or patients."